Inspection on 06/12/05 for Earlham House

This inspection was carried out on 6th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Earlham House 07/10/08

Earlham House 04/04/07

Earlham House 11/05/06

Earlham House 09/12/04

Earlham House 24/06/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Earlham House 7 Earlham Grove London N22 5HJ Lead Inspector Mr Teferi Degeneh Unannounced Inspection 6th December 2005 09:30 Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Earlham House Address 7 Earlham Grove London N22 5HJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8881 3064 020 8881 3064 Dr Peter Theodore Clayton Mrs Bridie Clayton Mrs Bridie Clayton Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three specified service users who are over 65 years of age may remain accommodated in the home. The home must advise the registering authority at such times as any of the specified service users vacates the home. 23rd August 2005 Date of last inspection Brief Description of the Service: Earlham House is a registered care home for seven adults with mental health needs. Three of the people currently living at the home are over 65 years of age. The home is privately owned with the registered manager also being the registered provider jointly with her husband.The home is a large converted domestic property, which is suitable to meet the needs of the current service users. The accommodation is spread over three floors with the first and second floors being on split levels and referred to below as front and back on each floor. The ground floor contains the communal facilities comprising a lounge and a large kitchen/ diner and also two service user bedrooms, one with ensuite and a shower and bathroom as well as the home’s laundry facilities. The first floor front contains three service user bedrooms and the first floor back contains one service user bedroom and a toilet and a bathroom with an adapted bath. The second floor back contains one service user bedroom and a shower room/ toilet. The second floor front contains the office and staff facilities. The home has a pleasant accessible rear garden.The home is located close to public transport and within easy walking distance of the multi-cultural amenities and shops in Wood Green. Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted over a period of seven hours, commencing at 9.30pm and concluding at approximately 4.30pm. Ms Margaret Samba, deputy manager was present during morning session of the inspection. The registered manager, Mrs Bridie Clayton, was present beginning at 1 pm. The inspection activity undertaken included a tour of the building, the examination of service users files including care records, the examination of health and safety records, the viewing of staff rotas and discussions with both care staff and the home’s management. What the service does well: What has improved since the last inspection? What they could do better: The registered person has a plan to make changes to the building in order to provide a new kitchen and lounge to improve the communal areas of the home. The manager believes that the work could be completed without disruption to the services provided and without affecting the health and safety of the people who live at the home. There was no written plan as to how these could be achieved. It is required that appropriate assessment must be undertaken to ensure that the provision of new kitchen and lounge must not Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 6 adversely affect the health and safety and welfare of the people who use the service. Advice must also be sought from the fire officers. It is also required that the staff attend mental health awareness and how to support people with mental health needs. The registered person needs to put in place an action plan as part of the system of quality assurance for the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, and 4 The home has a satisfactory admission procedure, which ensures that the needs of new service users are identified and care plans are formulated before their admission. Adequate arrangements are in place for service users to see the home and to check the facilities before moving into the home. EVIDENCE: A new person has been admitted since the last inspection. The file of this person and three files of existing people who use the service were assessed. It was evident from the files and a discussion with the registered person that the needs of each person who uses the service have been assessed by a social worker and the home. The registered person said each prospective service user is visited and assessed before a decision is made regarding their referral for admission. New service users are also encouraged to visit the home and see the services and facilities before accepting an offer of admission. The newly admitted service user was out attending their placement review meeting on the day of the inspection. However, one service user was able to confirm that they had an opportunity to visit the home before they were admitted. Another service user said they had previously lived at the home before temporarily moving to another home and returning. They said they liked this home better and that was why they wanted to move back to the home. Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9 The systems for care plan and risk assessment reviews are satisfactory. Service users benefit from these systems and they can be sure that their needs are identified and met by the home. Service users also benefit from the support the home provides to them to take risk as part of an independent life style. EVIDENCE: Service users’ care plans have been reviewed. The care plans are designed in a column format enabling the home to identify areas of needs, and the strengths/weaknesses, goals/objectives and the actions and the processes needed to meet the identified needs. The care plans are detailed covering areas of needs such as health, physical, psychiatric, accommodation, financial, behavioural and leisure needs of service users. It was clear from the files and discussions with the registered person that care plans are based on the comprehensive needs assessment of service users. Service users and the staff spoken to confirmed that service users are involved in the review of their care plans. Discussions and observation of service users indicated that service users can get up at a time of their choice and can make drinks and breakfast. All service users have a bedroom and front door keys. Service users have a bus pass, which they can use to travel independently. A number of service users Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 10 have a day activity. The atmosphere in the home was relaxed with service users feeling comfortable and interacting actively with the staff. The files assessed contained evidence of completed risk assessments. Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, and 17 There are satisfactory arrangements for people who use the service to engage in appropriate activities. These enabled service users’ social and leisure needs to be met. The meals provided at the home are good to meet service users’ expectations. Service users benefited from the home’s good facilities and attitude towards visitors. EVIDENCE: Discussions with three service users and the registered person confirmed that service users have a day activity. One service user said they attend a day centre and a club where they meet people and play games. Two service users said they are not interested in day activities but spend time watching television programmes and doing personal things. They said that they are happy with their day activity arrangements and they do not feel bored. The home is currently in the process of finding a suitable day activity for a newly admitted service user. Service users have a bank and post office account. From discussions with the registered person it was evident that the home supports service users with their benefits. A sample of the cash, records and receipts kept for three service users was checked and was found to be correct on the Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 12 day of the inspection. It was mentioned above that all service users have a bus pass and can travel independently. The registered person said the service users are registered on the electoral roll to vote. From discussion with the registered person it was evident that support is available for service users to attend places of worship. It was stated that one service user regularly attends a place of worship. Service users and the registered person confirmed that service users are visited by friends and families. All visits by relatives and friends were recorded either in the home’s diary or the visitors’ book. One service user said they regularly visit their family. There is a pay phone for use by service users. A service user was observed using the home’s telephone to speak to a member of their family. The people who live at the home are looking forward to their Christmas party, which is to take place on 14th December 2005. Discussions with the registered person and service users indicated that families and friends are invited to this party. Records and discussions with the registered person showed that service users go out to public houses, cafés, shops and the parks. Service users said they are happy with the meals provided at the home and that they are consulted about their preferences of the meals. The inspection of fridge, freezer and cupboards showed that there were sufficient amount of food items both in quantity and variety. Fresh fruits were also evident in the kitchen. The staff who prepare food have attended basic food hygiene training. Service users were observed in the kitchen taking part in the preparation of meals, washing up dishes and laying tables. The home has a plan to make changes to the kitchen and the sitting areas which would improve the quality of the service. Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 20 The systems good systems for handling and administration of medication and for enabling service users to health care. The home’s satisfactory policies and procedures, and the staff experience have enabled service users to receive personal support in the way they prefer and require. EVIDENCE: The registered person has a form in each service user’s file to show the type and date of health care they had. This includes visits to general practitioners, medication reviews, blood tests, and psychiatric appointments. Records were available in the files to confirm that service users attended appointments with opticians, dentist and a chiropodist. A letter in a service user’s file stated that a chiropodist is due to visit them at the home on 2nd March 2006. Feedback cards completed at the last inspection by health professionals are positive about the home. For example, a health professional was quoted in the last inspection report as follows: “In my opinion this is the best residential care home with which I have worked and gives an outstanding level of care.” The service users spoken to are happy with their personal care. They said the staff always knock on the doors before entering bedrooms and that their privacy is ensured. All the service users are registered with their own general practitioners. Medication is administered by the staff who have completed training on safe handling and administration of medication. A medication cabinet is kept locked in each service user’s bedroom. A fridge is available in Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 14 the office for keeping medicines provided in liquid form. Medicines and medication records were checked and were found to be correct on the day of the inspection. Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, and 23 Adequate policies, procedures and systems are in place to ensure that service users’ concerns are listened to and acted upon and service users are protected from abuse. These have given a feeling of reassurance, confidence and protection to service users. EVIDENCE: No complaints have been recorded since the last inspection. The service users spoken to confirmed that they can talk to the registered person and they know how to complain if they have concerns. The home’s complaints procedure is displayed on a notice board in the corridor. It was evident in the files that a copy of the complaint procedure has been attached to the service users’ guide. A feedback card completed by a relative and returned to the CSCI at the last inspection indicated that the relatives know about the home’s complaints procedure. At the last inspection a requirement was made for the registered person to ensure that persons working at the home have training in the protection of vulnerable adults from abuse. Records seen indicated that two members of staff attended POVA training on 30/11/05. The registered person stated that three care staff have attended POVA training as part of their NVQ qualification requirements. There is a procedure on the protection of vulnerable adults from abuse (POVA). The registered person has also obtained the placing authority’s procedure on POVA and this is reflected in the home’s relevant procedure. All staff employed at the home have undergone a CRB check. Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The location and facilities of the home are satisfactory to enable service users to live in a comfortable and safe environment. However, service users are not clear about the contingency arrangements to be put in place to ensure their safety and welfare while building work is carried out to provide a new kitchen and sitting area. EVIDENCE: Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 17 The home is located in a residential area within walking distance of Wood Green shopping complex. There are local shops, cafés and a bus stop very close to the home. The home was clean and tidy and there were offensive odours. The carpets throughout the premises were being cleaned professionally on the day of the inspection. There is also a cleaner working at the home five days a week. Service users stated that they are happy with their bedrooms. Satisfactory infection control policies and procedures are in place. An officer from the environmental health services confirmed that the kitchen areas were satisfactorily maintained. It was noted from previous inspection reports, pre-inspection questionnaire and a discussion with the registered person that there is a plan to make some changes to the structure of the building to enable the home to provide a bigger sitting area and a more suitable kitchen for the service users. The registered person is aware that issues relating to planning permission and risk assessment in respect of arrangements for service users while the work is in progress need to be specified and communicated to the CSCI. The service users confirmed that they are aware of the plan to make changes to the building and that they are excited about it. Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, and 34 Service users feel confident that the adequate number of staff available at the home meets their needs. The recruitment procedures of the home are satisfactory to ensure that suitable staff are recruited to meet the needs of service users. The registered person has made no progress regarding mental health awareness training for staff. This has limited the quality of service and support the staff can provide for service users. EVIDENCE: The home has seven care workers, a manager and a cleaner. The rotas showed that two care staff and the manager work between 8 am and 6 pm on Monday to Friday. Two care staff cover the time between 6 pm and 7 pm and from 7 pm to 8 am a night staff is on shift. The night staff is awake between 7 pm to 10 pm but is on sleep-in duty there after up to 8 am. It was stated above that most service users are out attending day activities during the day. The registered person is satisfied that the number of staff allocated is sufficient to meet the needs of the service users. The staff files and the staff spoken to confirmed that they have previous experience of working with vulnerable people in a care environment. The training records of the home indicated that the staff have attended training in core areas such as health and safety, care planning, protection of vulnerable adults from abuse, first aid, lifting and handling and basic food hygiene. At the last inspection the registered person was required to ensure that the staff have training in mental health care. This requirement is yet to be complied with. Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 19 The home has a recruitment policy. The registered person said job applications are short listed and candidates are interviewed. New staff start work only after two satisfactory written references are and a CRB’s are obtained. The assessed staff files have evidence of CRB, References, and various forms of staff identity. The staff spoken to confirmed that they were issued with contracts. Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, and 42 The management of the home is transparent and forward-looking. Service users benefit from the manager’s commitment to improve facilities and services. However, service users do not know the outcome and the actions taken by the manager in respect of the quality assurance system. While the building work to be undertaken is commended in view of the obvious intention of improving the kitchen and lounge facilities, the precautions taken so far to ensure the safety of the people who live at the home are not clear. Service users do not know how the home ensures fire safety. EVIDENCE: The registered manager is also a joint provider of the service with her husband. She was a qualified nurse but her registration has lapsed. The manager has embarked on NVQ (Management) Level 4 training. A deputy manager who is also undertaking training to achieve management qualification currently supports the manager. The registered person has been running the home for a number of years. The staff and the service users spoken to stated that the manager is open and approachable. Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 21 At the last inspection a requirement was made for the registered person regarding the full implementation of a quality assurance system. It was evident from previous inspections of documents and a discussion with the registered person a questionnaire has been distributed to and collected from service users and that feedback is sought from visitors when and as they contact the home. The registered person is aware that feedback obtained from service users and visitors need to be analysed and an action plan formulated in order to improve the quality of the services. It has been mentioned earlier that the home was clean and the staff have attended training in health and safety. All bedrooms are fitted with smoke detectors and records showed that fire alarms are checked weekly. Certificates were seen to confirm that emergency lights, call points, and fire extinguishers have been tested in May, July and August respectively. The gas boilers and the cookers were checked on 18/4/05 and the portable electrical test certificates dated 7/4/05 confirmed that all the appliances did not have faults. It was mentioned above that the registered person has a plan to make changes to the building to provide improved kitchen and sitting facilities. The registered person said that an architect has been commissioned to ensure that all relevant regulations, including fire safety, are complied with before, during and after the building work is completed. Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 3 3 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Earlham House Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 2 X DS0000010706.V264878.R01.S.doc Version 5.0 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 23; 17 Requirement The registered person must ensure the health and safety, and welfare of service users while providing a new kitchen and sitting area. The registered person must update the CSCI from time to time regarding the progress of the building work and the arrangements put in place to ensure safety and welfare of service users. The registered person must provide all members of the staff with training in mental health needs. (Time scale of 30/11/05 not met). The registered person must consult service users and visitors about the quality of services and facilities provided at the home. The feedback obtained through the quality assurance must be summarised with action plans and made available to all stakeholders including the CSCI. (Time scale of 30/01/06 not reached). The registered person must ensure that the local fire safety officer visits and inspects the DS0000010706.V264878.R01.S.doc Timescale for action 21/01/06 2 YA32 18(1) 31/03/06 3 YA39 24(1)(2) 31/03/05 4 YA42 23(4) 30/01/06 Earlham House Version 5.0 Page 24 premises and that any advice given is acted upon. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Earlham House DS0000010706.V264878.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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